Anthony Delitto, PT, PhD; Sara R. Piva, PT, PhD; Charity G. Moore, PhD, MSPH; Julie M. Fritz, PT, PhD; Stephen R. Wisniewski, PhD; Deborah A. Josbeno, PT, PhD; Mark Fye, MD; William C. Welch, MD
Grant Support: By the National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant AR-NS45622; Dr. Delitto).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1420.
Reproducible Research Statement:Study protocol: See Supplement 3 for more details. Statistical code: Available from Dr. Moore (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Anthony Delitto, PT, PhD, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 16260.
Current Author Addresses: Drs. Delitto, Piva, and Josbeno: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219.
Dr. Moore: Department of Medicine, University of Pittsburgh, M240 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261.
Dr. Fritz: Department of Physical Therapy, School of Health Professions, University of Utah, Health Profession Education Building, 520 Wakara Way, Salt Lake City, UT 84108.
Dr. Wisniewski: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 127 Parran Hall, Pittsburgh, PA 15261.
Dr. Fye: University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213.
Dr. Welch: University of Pennsylvania, Penn Neurosurgery, Pennsylvania Hospital, Washington Square West Building, 235 South 8th Street, Philadelphia, PA 19106.
Author Contributions: Conception and design: A. Delitto, J.M. Fritz, S.R. Wisniewski, W.C. Welch.
Analysis and interpretation of the data: A. Delitto, C.G. Moore, S.R. Wisniewski, W.C. Welch.
Drafting of the article: A. Delitto, S.R. Piva, C.G. Moore, J.M. Fritz, M. Fye, W.C. Welch.
Critical revision of the article for important intellectual content: A. Delitto, S.R. Piva, C.G. Moore, D.A. Josbeno, W.C. Welch.
Final approval of the article: A. Delitto, S.R. Piva, C.G. Moore, J.M. Fritz, M. Fye, W.C. Welch.
Provision of study materials or patients: M. Fye, W.C. Welch.
Statistical expertise: C.G. Moore, S.R. Wisniewski.
Obtaining of funding: A. Delitto, J.M. Fritz, W.C. Welch.
Administrative, technical, or logistic support: A. Delitto, S.R. Piva, D.A. Josbeno, M. Fye, W.C. Welch.
Collection and assembly of data: J.M. Fritz, S.R. Wisniewski, D.A. Josbeno, M. Fye, W.C. Welch.
Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al. Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial. Ann Intern Med. 2015;162:465-473. doi: 10.7326/M14-1420
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Published: Ann Intern Med. 2015;162(7):465-473.
Primary care management decisions for patients with symptomatic lumbar spinal stenosis (LSS) are challenging, and nonsurgical guidance is limited by lack of evidence.
To compare surgical decompression with physical therapy (PT) for LSS and evaluate sex differences.
Multisite randomized, controlled trial. (ClinicalTrials.gov: NCT00022776)
Neurologic and orthopedic surgery departments and PT clinics.
Surgical candidates with LSS aged 50 years or older who consented to surgery.
Surgical decompression or PT.
Primary outcome was physical function score on the Short Form-36 Health Survey at 2 years assessed by masked testers.
The study took place from November 2000 to September 2007. A total of 169 participants were randomly assigned and stratified by surgeon and sex (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the surgery and PT groups, respectively. Mean improvement in physical function for the surgery and PT groups was 22.4 (95% CI, 16.9 to 27.9) and 19.2 (CI, 13.6 to 24.8), respectively. Intention-to-treat analyses revealed no difference between groups (24-month difference, 0.9 [CI, −7.9 to 9.6]). Sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups.
Without a control group, it is not possible to judge success attributable to either intervention.
Surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates. Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS.
National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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